Intraoperative cell salvage in obstetrics

Abstract

Cell salvage is widely used in many surgical specialties to reduce the use of allogeneic blood, which is associated with well-recognized significant complications such as incorrect transfusion, acute and delayed immunological transfusion reactions and transfusion-transmitted infection. Theoretical concerns over the use of cell salvage in obstetrics have focused on the risk of Rhesus immunization and the risk of contamination of the cell-saved blood with traces of amniotic fluid. This article examines the in vitro and in vivo evidence for the safety of the technique, presents current usage figures from Wales and the entire UK, and discusses the current perception of amniotic fluid embolus as an anaphylactoid reaction. It suggests that patients will have to choose between the risks of allogeneic or cell-saved blood, and concludes that the balance of evidence is now in favour of cell salvage in obstetrics.